Spiritual assistance is one of the core areas in palliative care that any hospice or palliative care set up should not ignore.
It demotivates spiritual leaders when doctors see them as intruders in their quest to help patients in their end of life.
Reverend Patrick Kinyanjui is a spiritual leader working as a chaplain in hospitals in the larger Nakuru area and offers his services to Nakuru Hospice patients.
“We go around wards to do our assessment on patients and intervene as the situation appropriately demands.” Said Kinyanjui after attending a Continuous Medical Education (CME) conducted by Kenya Hospices and Palliative Care Association (KEHPCA).
He said that medical practitioners do not seem to recognize them as important players in a patient’s life during their end of life. They see them as intruders in their profession.
Reverend Kinyanjui said spiritual guidance is very effective to these patients adding that even those that he has taken through such help in the Intensive Care Unit and survived have testified.
“I have attended a course in palliative care and I understand the need for spiritual help during this period of the patient’s life.” He said.
Reverend Kinyanjui said it is therefore important that medical doctors recognize their role and give spiritual leaders a chance to attend to patients.
He said that medical practitioners should refer patients to spiritual leaders at the time when they are certain that their ailment is life threatening so that they can prepare them spiritually towards their end of life.
“We listen, hear and attend to these patient’s spiritual needs and the earlier we are allowed to perform this duty, the more effective we will become in palliative care provision. We are called for trainings but they are not making good use of us out there.” He said.
His counterpart Haron Wainaina said that they are volunteers in this field hence no need to see them as intruders.
“Though we have financial needs, we give these services heartily because we understand the need these patients are in. We were many initially but most have left due to such challenges but we are still strong in our spiritual service delivery.” Wainaina said.
The two spiritual caregivers were part of over 70 health care providers who attended the CME to gain more insight into the concept of palliative care and pain management.
The session was carried out within Nakuru Provincial General Hospital premises where doctors, clinicians, pharmacists and students in the nursing field had an opportunity to attend.
KEHPCA’s Special Coordinator for access to pain relief and palliative care Dr Esther Muinga explained to participants that palliative care should begin from the time of diagnosis to help the patient accept the health condition at hand.
Dr Muinga said that palliative care is a multidisciplinary field involving several health care providers and the community at large, not leaving out the patient’s family.
After raising concerns that the palliative care department within the hospital had not been allocated a room to operate from, Dr Muinga asserted that a hospice is not a building but a philosophy of care to patients with life threatening illnesses adding that palliative care can be undertaken in a simple setting.
She elaborated how palliative care revolves around various issues including the patient’s culture, spiritual believes, social status, psychological status, notwithstanding the patient’s physical state.
Education and Research officer from KEHPCA Dr Asaph Kinyanjui explained in depth the concept of pain management to the health care providers.
Dr Kinyanjui said it is necessary for a care provider to establish what the patient thinks is the cause of the pain in order to take an appropriate step in treating it.
“If a patient believes s/he has been bewitched, s/he may not embrace the therapy you are going to administer because a patient believes that witchcraft has no medical cure.” Dr Kinyanjui said.
Despite research indicating that less than 1% of patient using morphine showed signs of addiction, the health care providers were reluctant to prescribe morphine freely to patients with acute pain.
Dr Kinyanjui attributed this to lack of practice during training and advised them to volunteer with Nakuru Hospice so that they can have a practical experience on the use of morphine in the alleviation of pain.
Despite having no room to operate from, the nurse in charge of palliative care at the hospital Mercy Wachiuri said they are determined in their service and they go around wards to offer palliative care.
Wachiuri said she is optimistic that sooner they will be given a place where they can attend to patients.
“We see patients with ailments ranging from cancer of the cervix, cancer of the oesophagus, Kaposi sarcoma to breast cancer.” She said.
She said that pain management has been an issue with most of the health care providers but she was hopeful that the situation would greatly improve after the training.
Wachiuri added that the hospital currently has no df118 and morphine but was grateful that they can refer patients to Nakuru Hospice, situated just a few meters away.
She was thankful to KEHPCA for the continued training saying that such trainings go a long way in sensitizing health care providers on the importance of palliative care, giving them the courage to freely use morphine when necessary and appropriately.